Knee arthroplasty with modular femoral adapters

ABSTRACT

An arthroplasty system may include a first prosthesis to be fixed to a first bone of a joint, a second prosthesis to be fixed to a second bone of the joint for articulation with the first prosthesis, and one or more adapters to be fixed to the first prosthesis for articulation with the second prosthesis to modify the stability of the second prosthesis relative to the first prosthesis. The system may include one or more articular inserts to be coupled to the second prosthesis for articulation with the first prosthesis and/or the adapter(s). The articular inserts may be fixed or mobile bearing relative to the second prosthesis. Each adapter and corresponding articular insert may modify stability differently.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application claims the benefit of:

U.S. Provisional Patent Application No. 62/563,108, filed Sep. 26, 2017,entitled IMPLANTABLE ORTHOPEDIC KNEE JOINT PROSTHESES, KITS, AND METHODSWITH REMOVABLE FEMORAL ADAPTORS.

The foregoing is incorporated by reference as though set forth herein inits entirety.

TECHNICAL FIELD

The present disclosure relates to implantable medical devices. Morespecifically, the present disclosure relates to arthroplasty systemswith modular adapters to provide various degrees of constraint orstability between articulating prostheses. While the current disclosureis made in the context of knee arthroplasty, the principles describedherein are applicable to arthroplasty systems for other joints aroundthe body.

BACKGROUND

Arthroplasty prostheses are designed to articulate together to providemotion at a joint. The prostheses may be designed with more or lessconstraint in the articulation, according to the design rationale andintended use. For example, in knee arthroplasty, less constrainedprostheses may be designed for use in patients with robust soft tissuestructures around the knee, for example in primary (first) surgeries.Less constrained prostheses tend to provide greater range of motion.More highly constrained prostheses may be designed for use in patientswhose soft tissues and/or other anatomical structures of the knee arecompromised, as is often the case in revision (second and subsequent)surgeries. More constrained prostheses tend to provide greater stabilityto the articulation.

Two types of constrained knee prostheses are the constrained condylarknee (CCK) and the hinged knee. A CCK design may be used to counteractanterior-posterior laxity or instability and/or lateral collateralligament (LCL) laxity in patients with an intact medial collateralligament (MCL) where the surgeon achieves stability when the knee isflexed to 90 degrees (a stable “flexion space”). A CCK design providesstability in the anterior-posterior direction and/or mild medial-lateralstability. A hinge design may be used in patients with a deficient MCLor a flexion space that is too large (unstable). A hinge design providesstability in the anterior-posterior and medial-lateral directions, andcan stabilize an unstable flexion space. Conventionally, a surgeondecides upon a constrained prosthesis during preoperative planning.

There is a need for arthroplasty technology that enables a surgeon tochoose a constraint level during the arthroplasty procedure, forexample, choosing a CCK or hinged knee during a knee arthroplastyprocedure. There is also a need for arthroplasty technology that enablesa surgeon to convert a prosthesis from one constraint level to anotherin a subsequent procedure, for example, converting apreviously-implanted CCK knee to a hinged knee, or vice versa, in asubsequent relatively minor surgery.

SUMMARY

The various systems and methods of the present technology have beendeveloped in response to the present state of the art, and inparticular, in response to the problems and needs in the art that havenot yet been fully solved by currently available arthroplasty systems.The systems and methods of the present technology may provide adaptersand articular inserts that may be selected intraoperatively during aninitial surgery, or during a later revision surgery, to modify thestability of an arthroplasty system.

To achieve the foregoing, and in accordance with the technology asembodied and broadly described herein, in an aspect of the technology,an arthroplasty system for a joint between a first bone and a secondbone, the system including: a first arthroplasty prosthesis with areceptacle, wherein the first arthroplasty prosthesis is configured tobe fixed to the first bone and to articulate against a secondarthroplasty prosthesis which is configured to be fixed to the secondbone, so as to provide a range of motion between the first and secondarthroplasty prostheses; and an adapter removably fixed in thereceptacle, wherein the adapter includes a first constraint feature forconstrained articulation against a complementary second constraintfeature of the second arthroplasty prosthesis to modify the range ofmotion.

Embodiments of this aspect may include any of the following attributes.The adapter is insertable into, fixable within, and removable from thereceptacle when the first arthroplasty prosthesis is fixed to the firstbone. The adapter goes into the receptacle along a direction that isgenerally parallel to a mechanical axis of the first bone when the firstarthroplasty prosthesis is fixed to the first bone. The receptacleincludes an alcove extending into the first arthroplasty prosthesisalong the direction, a first insertion stop feature, and a first removalstop feature, wherein the alcove includes a non-circular cross-sectionalshape perpendicular to the direction; wherein the adapter includes anon-circular exterior cross-sectional shape perpendicular to thedirection, a second insertion stop feature, and a second removal stopfeature, wherein the adapter exterior cross-sectional shape iscomplementary to the alcove cross-sectional shape; wherein when theadapter is in the receptacle, the adapter exterior cross-sectional shapefits closely within the alcove cross-sectional shape, the first andsecond insertion stop features are engaged to prevent over-insertion ofthe adapter into the receptacle, and the first and second removal stopfeatures are engaged to prevent unintentional removal of the adapter outof the receptacle, wherein the first and second removal stop featuresare disengageable. The adapter goes into the receptacle along adirection that is generally perpendicular to a mechanical axis of thefirst bone when the first arthroplasty prosthesis is fixed to the firstbone. The receptacle includes an alcove extending into the firstarthroplasty prosthesis along the direction, a first insertion stopfeature, and a first removal stop feature, wherein the alcove includes anon-circular cross-sectional shape perpendicular to the direction;wherein the adapter includes a non-circular exterior cross-sectionalshape perpendicular to the direction, a second insertion stop feature,and a second removal stop feature, wherein the adapter exteriorcross-sectional shape is complementary to the alcove cross-sectionalshape; wherein when the adapter is in the receptacle, the adapterexterior cross-sectional shape fits closely within the alcovecross-sectional shape, the first and second insertion stop features areengaged to prevent over-insertion of the adapter into the receptacle,and the first and second removal stop features are engaged to preventunintentional removal of the adapter out of the receptacle, wherein thefirst and second removal stop features are disengageable. The firstconstraint feature includes a cavity; wherein the second constraintfeature includes a protrusion received in the cavity so that when thejoint is extended, the second arthroplasty prosthesis has limitedtranslation along a direction that is generally perpendicular to amechanical axis of the first bone, and so that when the joint is flexed,the second arthroplasty prosthesis has limited translation along adirection that is generally parallel to the mechanical axis of the firstbone. The first constraint feature includes a main body coupled to asleeve by a hinge so that the sleeve rotates relative to the main bodyabout a hinge axis, wherein the sleeve includes a bore; wherein thefirst constraint feature further includes a shaft that is fixed in thebore; wherein the second constraint feature includes a hole thatreceives the shaft, so that the shaft rotates within the hole about acentral longitudinal shaft axis and translates within the hole along theshaft axis.

In another aspect of the technology, an arthroplasty system for a jointbetween a first bone and a second bone, the system including: a firstarthroplasty prosthesis configured to be fixed to the first bone,wherein the first arthroplasty prosthesis includes a receptacle; anadapter removably fixed in the receptacle, wherein the adapter includesa first constraint feature; and a second arthroplasty prosthesisconfigured to be fixed to the second bone, wherein the first and secondarthroplasty prostheses articulate together to provide a range of motionbetween the first and second arthroplasty prostheses, wherein the secondarthroplasty prosthesis includes a second constraint feature thatarticulates against the first constraint feature to increase stabilityof the first arthroplasty prosthesis relative to the second arthroplastyprosthesis.

Embodiments of this aspect may include any of the following attributes.The adapter is insertable into, fixable within, and removable from thereceptacle when the first arthroplasty prosthesis is fixed to the firstbone. The adapter goes into the receptacle along a direction that isgenerally parallel to a mechanical axis of the first bone when the firstarthroplasty prosthesis is fixed to the first bone. The receptacleincludes an alcove extending into the first arthroplasty prosthesisalong the direction, a first insertion stop feature, and a first removalstop feature, wherein the alcove includes a non-circular cross-sectionalshape perpendicular to the direction; wherein the adapter includes anon-circular exterior cross-sectional shape perpendicular to thedirection, a second insertion stop feature, and a second removal stopfeature, wherein the adapter exterior cross-sectional shape iscomplementary to the alcove cross-sectional shape; wherein when theadapter is in the receptacle, the adapter exterior cross-sectional shapefits closely within the alcove cross-sectional shape, the first andsecond insertion stop features are engaged to prevent over-insertion ofthe adapter into the receptacle, and the first and second removal stopfeatures are engaged to prevent unintentional removal of the adapter outof the receptacle, wherein the first and second removal stop featuresare disengageable. The adapter goes into the receptacle along adirection that is generally perpendicular to a mechanical axis of thefirst bone when the first arthroplasty prosthesis is fixed to the firstbone. The receptacle includes an alcove extending into the firstarthroplasty prosthesis along the direction, a first insertion stopfeature, and a first removal stop feature, wherein the alcove includes anon-circular cross-sectional shape perpendicular to the direction;wherein the adapter includes a non-circular exterior cross-sectionalshape perpendicular to the direction, a second insertion stop feature,and a second removal stop feature, wherein the adapter exteriorcross-sectional shape is complementary to the alcove cross-sectionalshape; wherein when the adapter is in the receptacle, the adapterexterior cross-sectional shape fits closely within the alcovecross-sectional shape, the first and second insertion stop features areengaged to prevent over-insertion of the adapter into the receptacle,and the first and second removal stop features are engaged to preventunintentional removal of the adapter out of the receptacle, wherein thefirst and second removal stop features are disengageable. The firstconstraint feature includes a cavity; wherein the second constraintfeature includes a protrusion received in the cavity so that when thejoint is extended, the second arthroplasty prosthesis has limitedtranslation along a direction that is generally perpendicular to amechanical axis of the first bone, and so that when the joint is flexed,the second arthroplasty prosthesis has limited translation along adirection that is generally parallel to the mechanical axis of the firstbone. The first constraint feature includes a main body coupled to asleeve by a hinge so that the sleeve rotates relative to the main bodyabout a hinge axis, wherein the sleeve includes a bore; wherein thefirst constraint feature further includes a shaft that is fixed in thebore; wherein the second constraint feature includes a hole thatreceives the shaft, so that the shaft rotates within the hole about acentral longitudinal shaft axis and translates within the hole along theshaft axis.

In another aspect of the technology, an arthroplasty system for a jointbetween a first bone and a second bone, the system including: an adapterincluding a first constraint feature, wherein the adapter is removablyfixable to a first arthroplasty prosthesis, wherein the firstarthroplasty prosthesis is configured to be fixed to the first bone; anda second arthroplasty prosthesis including a second constraint feature,wherein the second arthroplasty prosthesis is configured to be fixed tothe second bone and to articulate against the first arthroplastyprosthesis; wherein the second constraint feature articulates againstthe first constraint feature to increase stability of the firstarthroplasty prosthesis relative to the second arthroplasty prosthesis.

Embodiments of this aspect may include any of the following attributes.The adapter is fixable to, and removable from, the first arthroplastyprosthesis when the first arthroplasty prosthesis is fixed to the firstbone. The adapter is fixable to, and removable from, the firstarthroplasty prosthesis along a direction that is generally parallel toa mechanical axis of the first bone when the first arthroplastyprosthesis is fixed to the first bone. The adapter is fixable to, andremovable from, the first arthroplasty prosthesis along a direction thatis generally perpendicular to a mechanical axis of the first bone whenthe first arthroplasty prosthesis is fixed to the first bone. The firstconstraint feature includes a cavity; wherein the second constraintfeature includes a protrusion received in the cavity so that when thejoint is extended, the second arthroplasty prosthesis has limitedtranslation along a direction that is generally perpendicular to amechanical axis of the first bone, and so that when the joint is flexed,the second arthroplasty prosthesis has limited translation along adirection that is generally parallel to the mechanical axis of the firstbone. The first constraint feature includes a main body coupled to asleeve by a hinge so that the sleeve rotates relative to the main bodyabout a hinge axis, wherein the sleeve includes a bore; wherein thefirst constraint feature further includes a shaft that is fixed in thebore; wherein the second constraint feature includes a hole thatreceives the shaft, so that the shaft rotates within the hole about acentral longitudinal shaft axis and translates within the hole along theshaft axis.

These and other features and advantages of the present technology willbecome more fully apparent from the following description and appendedclaims, or may be learned by the practice of the technology as set forthhereinafter.

BRIEF DESCRIPTION OF THE DRAWINGS

Exemplary embodiments of the technology will become more fully apparentfrom the following description and appended claims, taken in conjunctionwith the accompanying drawings. Understanding that these drawings depictonly exemplary embodiments and are, therefore, not to be consideredlimiting of the scope of the technology, the exemplary embodiments willbe described with additional specificity and detail through use of theaccompanying drawings in which:

FIG. 1 is an oblique view of a knee arthroplasty system, in extension;

FIG. 2 is an oblique exploded view of the knee arthroplasty system ofFIG. 1;

FIG. 3 is an oblique view of a femoral component of the kneearthroplasty system of FIG. 1;

FIG. 4 is another oblique view of the femoral component of FIG. 3, froma different direction;

FIG. 5 is an oblique view of an adapter of the knee arthroplasty systemof FIG. 1;

FIG. 6 is another oblique view of the adapter of FIG. 5, from adifferent direction;

FIG. 7 is an oblique view of a tibial articular insert of the kneearthroplasty system of FIG. 1;

FIG. 8 is another oblique view of the tibial articular insert of FIG. 7,from a different direction;

FIG. 9 is an oblique view of a tibial baseplate of the knee arthroplastysystem of FIG. 1;

FIG. 10 is another oblique view of the tibial baseplate of FIG. 9, froma different direction;

FIG. 11 is an anterior view of the knee arthroplasty system of FIG. 1,in extension;

FIG. 12 is a cross-sectional view of the knee arthroplasty system ofFIG. 11, taken along section line 12-12 of FIG. 11;

FIG. 13 is a medial view of the knee arthroplasty system of FIG. 1, inextension;

FIG. 14 is a cross-sectional view of the knee arthroplasty system ofFIG. 13, taken along section line 14-14 of FIG. 13;

FIG. 15 is an anterior view of the knee arthroplasty system of FIG. 1,in flexion;

FIG. 16 is a cross-sectional view of the knee arthroplasty system ofFIG. 15, taken along section line 16-16 of FIG. 15;

FIG. 17 is an anterior exploded view of the femoral component andadapter of the knee arthroplasty system of FIG. 15;

FIG. 18 is an anterior view of the assembled femoral component andadapter of the knee arthroplasty system of FIG. 15;

FIG. 19 is an oblique view of another tibial articular insert for use inthe knee arthroplasty system of FIG. 1;

FIG. 20 is another oblique view of the tibial articular insert of FIG.19, from a different direction;

FIG. 21 is an oblique view of another knee arthroplasty system, inextension;

FIG. 22 is an oblique exploded view of the knee arthroplasty system ofFIG. 21;

FIG. 23 is an oblique view of an adapter body of the knee arthroplastysystem of FIG. 21;

FIG. 24 is another oblique view of the adapter body of FIG. 23, from adifferent direction;

FIG. 25 is an oblique view of a sleeve of the knee arthroplasty systemof FIG. 21;

FIG. 26 is another oblique view of the sleeve of FIG. 25, from adifferent direction;

FIG. 27 is an oblique view of a post of the knee arthroplasty system ofFIG. 21;

FIG. 28 is another oblique view of the post of FIG. 27, from a differentdirection;

FIG. 29 is an oblique view of a tibial articular insert of the kneearthroplasty system of FIG. 21;

FIG. 30 is another oblique view of the tibial articular insert of FIG.29, from a different direction;

FIG. 31 is an anterior view of the knee arthroplasty system of FIG. 21,in extension;

FIG. 32 is a cross-sectional view of the knee arthroplasty system ofFIG. 31, taken along section line 32-32 of FIG. 31;

FIG. 33 is a medial view of the knee arthroplasty system of FIG. 21, inextension;

FIG. 34 is a cross-sectional view of the knee arthroplasty system ofFIG. 33, taken along section line 34-34 of FIG. 33;

FIG. 35 is an anterior view of the knee arthroplasty system of FIG. 21,in flexion;

FIG. 36 is a cross-sectional view of the knee arthroplasty system ofFIG. 35, taken along section line 36-36 of FIG. 35;

FIG. 37 is an anterior exploded view of the femoral component andadapter of the knee arthroplasty system of FIG. 35;

FIG. 38 is an anterior view of the assembled femoral component andadapter of the knee arthroplasty system of FIG. 35;

FIG. 39 is an oblique view of yet another knee arthroplasty system, inextension;

FIG. 40 is an oblique exploded view of the knee arthroplasty system ofFIG. 39;

FIG. 41 is an oblique view of a femoral component of the kneearthroplasty system of FIG. 39;

FIG. 42 is another oblique view of the femoral component of FIG. 41,from a different direction;

FIG. 43 is an oblique view of an adapter of the knee arthroplasty systemof FIG. 39;

FIG. 44 is another oblique view of the adapter of FIG. 43, from adifferent direction;

FIG. 45 is an anterior view of the knee arthroplasty system of FIG. 39,in extension;

FIG. 46 is a cross-sectional view of the knee arthroplasty system ofFIG. 45, taken along section line 46-46 of FIG. 45;

FIG. 47 is a medial view of the knee arthroplasty system of FIG. 39, inextension;

FIG. 48 is a cross-sectional view of the knee arthroplasty system ofFIG. 47, taken along section line 48-48 of FIG. 47;

FIG. 49 is an anterior exploded view of the femoral component andadapter of the knee arthroplasty system of FIG. 45;

FIG. 50 is an anterior view of the assembled femoral component andadapter of the knee arthroplasty system of FIG. 45;

FIG. 51 is an oblique view of yet another knee arthroplasty system, inextension;

FIG. 52 is an oblique exploded view of the knee arthroplasty system ofFIG. 51;

FIG. 53 is an oblique view of an adapter of the knee arthroplasty systemof FIG. 51;

FIG. 54 is another oblique view of the adapter of FIG. 53, from adifferent direction;

FIG. 55 is an anterior view of the knee arthroplasty system of FIG. 51,in extension;

FIG. 56 is a cross-sectional view of the knee arthroplasty system ofFIG. 55, taken along section line 56-56 of FIG. 55;

FIG. 57 is a medial view of the knee arthroplasty system of FIG. 51, inextension;

FIG. 58 is a cross-sectional view of the knee arthroplasty system ofFIG. 57, taken along section line 58-58 of FIG. 57;

FIG. 59 is an anterior exploded view of the femoral component andadapter of the knee arthroplasty system of FIG. 55; and

FIG. 60 is an anterior view of the assembled femoral component andadapter of the knee arthroplasty system of FIG. 55.

DETAILED DESCRIPTION

Exemplary embodiments of the technology will be best understood byreference to the drawings, wherein like parts are designated by likenumerals throughout. It will be readily understood that the componentsof the technology, as generally described and illustrated in the figuresherein, could be arranged and designed in a wide variety of differentconfigurations. Thus, co the following more detailed description of theembodiments of the apparatus, system, and method is not intended tolimit the scope of the invention, as claimed, but is merelyrepresentative of exemplary embodiments of the technology.

The phrases “connected to,” “coupled to” and “in communication with,”and equivalents, refer to any form of interaction between two or moreentities, including mechanical, electrical, magnetic, electromagnetic,fluid, and thermal interaction. Two components may be functionallycoupled to each other even though they are not in direct contact witheach other. The term “abutting” refers to items that are in directphysical contact with each other, although the items may not necessarilybe attached together. The phrase “fluid communication” refers to twofeatures that are connected such that a fluid within one feature is ableto pass into the other feature.

The phrase “fixed to,” and equivalents, refers to two or more entitiesthat are coupled together so as to substantially eliminate relativemotion between the entities. Two entities may be functionally fixed toeach other even though they are not in direct contact with each other.

The word “exemplary” is used herein to mean “serving as an example,instance, or illustration.” Any embodiment described herein as“exemplary” is not necessarily to be construed as preferred oradvantageous over other embodiments. While the various aspects of theembodiments are presented in drawings, the drawings are not necessarilydrawn to scale unless specifically indicated.

Standard medical planes of reference and descriptive terminology areemployed in this specification. While these terms are commonly used torefer to the human body, certain terms are applicable to physicalobjects in general. In this specification, standard knee anatomicalterms are employed with their ordinary and customary meanings.

A standard system of three mutually perpendicular reference planes isemployed. A sagittal plane, or lateral plane, divides a body into rightand left portions. A coronal plane, or frontal plane, divides a bodyinto anterior and posterior portions. A transverse plane, or axialplane, divides a body into superior and inferior portions. The sagittal,coronal, and transverse planes are mutually perpendicular. Amid-sagittal, mid-coronal, or mid-transverse plane divides a body intoequal portions, which may be bilaterally symmetric. The intersection ofthe sagittal and coronal planes defines a superior-inferior orcephalad-caudal axis. The intersection of the sagittal and transverseplanes defines an anterior-posterior axis. The intersection of thecoronal and transverse planes defines a medial-lateral axis. Thesuperior-inferior or cephalad-caudal axis, the anterior-posterior axis,and the medial-lateral axis are mutually perpendicular.

Anterior means toward the front of a body. Posterior means toward theback of a body. Superior or cephalad means toward the head. Inferior orcaudal means toward the feet or tail. Medial means toward the midline ofa body, particularly toward a plane of bilateral symmetry of the body.Lateral means away from the midline of a body or away from a plane ofbilateral symmetry of the body. Axial means toward a central axis of abody. Abaxial means away from a central axis of a body. Ipsilateralmeans on the same side of the body. Contralateral means on the oppositeside of the body. Proximal means toward the trunk of the body. Proximalmay also mean toward a user or operator. Distal means away from thetrunk. Distal may also mean away from a user or operator. Dorsal meanstoward the top of the foot. Plantar means toward the sole of the foot.Varus means deviation of the distal part of the leg below the kneeinward, resulting in a bowlegged appearance. Valgus means deviation ofthe distal part of the leg below the knee outward, resulting in aknock-kneed appearance.

An anatomical axis of a long bone extends along the bone and is centeredin the diaphysis, or shaft. A mechanical axis of a long bone extendsalong the bone between the centers of its epiphyses (articular ends).For example, the mechanical axis of the femur extends between the centerof the femoral head at the proximal end and the center of theintercondylar notch at the distal end.

An arthroplasty system may include one or more arthroplasty prostheses,each of which may be a unitary component or an assembly of multiplecomponent. For example, a knee arthroplasty system may include a femoralprosthesis, a tibial prosthesis, and/or a patellar prosthesis, each ofwhich may be a unitary component or an assembly of multiple components.An arthroplasty system may also include surgical instruments forpreparing the bone, determining implant sizes, and inserting or removingprostheses.

In this specification, “substantially” means ±15% for linearmeasurements and ±22.5° for angular measurements. “Generally” means ±30%for linear measurements and ±45° for angular measurements.

Referring to FIGS. 1-18, a knee arthroplasty system 100 may include afemoral prosthesis 102 and/or a tibial prosthesis 104. This embodimentmay be referred to as a distal CCK fixed design. A left knee design isshown. The femoral prosthesis 102 may include a femoral component 106and an adapter 108. The femoral prosthesis 102 may include additionalcomponents, such as a femoral intramedullary stem (not shown) ordefect-filling augments (not shown). Referring to FIGS. 11-14, axis 103corresponds to the femoral mechanical axis. The tibial prosthesis 104may include a tibial articular insert 110 and a tibial baseplate 112, orthe tibial articular insert and tibial baseplate may be integrallyformed as a single component. The tibial prosthesis 104 may includeadditional components, such as an intramedullary stem (not shown) ordefect-filling augments (not shown).

The femoral component 106 includes a bone-facing side 114 and anopposite articular side 116. The bone-facing side 114 is configured tobe fixed against a resected distal femur, for example by bone cement,press fit, or bone growth onto/into the bone-facing side. Thebone-facing side 114 may include multiple portions corresponding toconventional anterior, anterior chamfer, distal, posterior chamfer,and/or posterior femoral resections. The bone-facing side 114 mayinclude a pedestal 118 and/or a socket 120. The pedestal 118 in thisexample is a rectangular feature that protrudes superiorly from thesurrounding bone-facing side. The pedestal 118 provides structuralsupport for the socket 120, which protrudes superiorly from the superioraspect of the pedestal. The socket 120 may include a hole 122 to receivea femoral intramedullary stem (not shown). Referring to FIG. 14, thesocket 120 and hole 122 are shown oriented along a generallysuperior-inferior axis 107 which may correspond to the femoralanatomical axis, also referred to as the femoral shaft axis. Thearticular side 116 is configured to articulate against a complementaryarticular side 184 of the tibial prosthesis 104, or against a naturalarticular surface of the proximal tibia. The articular side 116 may wraparound the anterior, distal, and posterior aspects of the femoralcomponent 106 to replicate some or all of the natural articular surfacesof the distal femur.

The femoral component 106 includes a receptacle 124, or space or alcove,which extends proximally into the distal aspect of the femoral componentbetween the medial and lateral condyles 126, 128. The receptacle 124receives the adapter 108 or the adapter 308. Referring to FIG. 12, thereceptacle 124 is shown extending along a direction that is parallel tothe axis 103. Referring to FIG. 17, the receptacle 124 has anon-circular cross-sectional shape perpendicular to the axis 103. Asubstantially rectangular cross-sectional shape is shown, although anyshape that resists rotation about the axis 103 may be used. Morespecifically, in this example, the receptacle 124 has planar medial andlateral walls 130, 132, an arcuate anterior wall 134, and asubstantially open posterior aspect 136 with medial and lateralposterior grooves 138, 140 that are shown extending parallel to the axis103. In other examples, there may also be medial and lateral anteriorgrooves so that together, the medial posterior and anterior grooves forma medial undercut channel, and the lateral posterior and anteriorgrooves form a lateral undercut channel. Examples of undercut channelsinclude dovetail channels, T-slots, and the like. The receptacle 124 mayinclude one or more insertion stop features which prevent over-insertionof the adapter 108 or 308 into the receptacle. Medial and lateralposterior-superior insertion stop features 142, 144 are shown at thesuperior ends of the medial and lateral posterior grooves 138, 140.Another insertion stop feature 146 may be formed by the inferior side ofthe socket 120. Medial and lateral slots 148, 150 extend superiorly intothe distal aspect of the femoral component 106 a short distance alongthe medial and lateral walls 130, 132. The superior walls of the slots148, 150 may function as insertion stops.

The adapter 108 is received in the receptacle 124 of the femoralcomponent 106 along a direction from the articular side 116 toward thebone-facing side 114. This means that the adapter 108 may be insertedinto, fixed within, and removed from the receptacle 124 while thefemoral component 106 is fixed to the distal femur, during the initialsurgical procedure or during a subsequent surgical procedure. In thisexample, the adapter 108 is inserted along a distal-to-proximaldirection parallel to the axis 103. However, the adapter 108 may beinserted along other directions, such as anterior-to-posteriorperpendicular to the axis 103 as discussed below, or along obliquedirections, such as distal-anterior to proximal-posterior at a 45 degreeangle to the axis 103. The adapter insertion direction may be based uponthe particular characteristics of the joint and arthroplasty prosthesis.

The adapter 108 has an exterior shape which is complementary to theshape of the receptacle 124. Referring to FIG. 17, the adapter 108 has anon-circular exterior cross-sectional shape perpendicular to the axis103. A substantially rectangular cross-sectional shape is shown,although any shape that resists rotation about the axis 103 may be used.More specifically, in this example, the adapter 108 has planar medialand lateral walls 152, 154, a planar superior wall 156 with an arcuateanterior border 158, and a planar posterior wall 160 with medial andlateral posterior ridges 162, 164 that are shown extending parallel tothe axis 103. The distal and anterior aspects are open. This examplealso includes medial and lateral anterior ridges 166, 168 so thattogether, the medial posterior and anterior ridges 162, 166 form amedial undercut rail, and the lateral posterior and anterior ridges 164,168 form a lateral undercut rail. Examples of undercut rails includedovetail rails, T-rails, and the like. The adapter 108 may include oneor more insertion stop features which prevent over-insertion of theadapter into the receptacle 124. The superior ends of the medial andlateral posterior ridges 162, 164 may function as insertion stopsagainst the medial and lateral posterior-superior insertion stopfeatures 142, 144 of the femoral component 106, and the superior wall156 in the vicinity of the arcuate anterior border 158 may function asan insertion stop against the inferior side of the socket 120. Theadapter 108 may include medial and lateral protrusions 170, 172 whichextend outwardly medially from the medial wall 152 and laterally fromthe lateral wall 154, respectively. The superior sides of theprotrusions 170, 172 may function as insertion stops against thesuperior walls of the slots 148, 150. The protrusions 170, 172 mayinclude through holes 174, 176 which extend along a superior-inferiordirection. The holes 174, 176 may receive fasteners (not shown). A hole178 may extend through the superior wall 156 along the superior-inferiordirection. The hole 178 may engage an adapter insertion and/or removaltool (not shown). The walls 152, 154, 156, 160 define an interior cavity180 or space, which may be substantially rectangular. The cavity 180 maybe referred to as a constraint feature. The cavity 180 may include a camfor interaction with the second articular portion 190 of the tibialarticular insert 110, described below.

The femoral prosthesis 102 may be assembled by orienting the adapter 108relative to the femoral component 106 as shown in FIG. 2; sliding theadapter into the receptacle 124; sliding the medial and lateralprotrusions 170, 172 into the medial and lateral slots 148, 150 until atleast one adapter insertion stop feature contacts a femoral componentinsertion stop feature; and fixing the adapter to the femoral component.The adapter 108 may slide into the receptacle along a direction from thearticular side 116 toward the bone-facing side 114, which in thisexample is from distal to proximal. The protrusions 170, 172 may slideinto the slots 148, 150 along the same direction. The adapter 108 may befixed to the femoral component 106 by inserting fasteners (not shown)through the holes 174, 176 of the protrusions 170, 172 and into thesuperior walls of the slots 148, 150. The protrusions 170, 172, holes174, 176, and slots 148, 150 may thus be referred to as removal stopfeatures which prevent unintentional removal of the adapter from thereceptacle, in combination with the fasteners. The removal stop featuresmay be disengaged by removing the fasteners.

When the femoral prosthesis 102 is assembled, the femoral component 106and the adapter 108 are fixed together. The adapter is insertable into,fixable within, and removable from the receptacle 124 when the femoralprosthesis 102 is fixed to a distal femur. The adapter isinterchangeable with other distal adapters, such as adapter 308discussed below.

The tibial articular insert 110 includes a bone-facing side 182 and anopposite articular side 184. The bone-facing side 182 is configured tobe coupled to the tibial baseplate 112, and may be referred to as abaseplate-facing side or a distal side. The bone-facing side 182 mayinclude a locking feature 186 to fix the tibial articular insert 110 tothe tibial baseplate 112, although mobile bearing configurations arealso contemplated. The articular side 184 may include a first articularportion 188 for articulation against the articular side 116 of thefemoral component 106. The first articular portion 188 may replicate thenatural medial and lateral tibial articular condyles. The articular side184 may also include a second articular portion 190, which in thisexample may protrude proximally from the first articular portion 188.The second articular portion 190 may be referred to as a constraintfeature. The second articular portion 190 in this example is forarticulation within the cavity 180 of the adapter 108.

The tibial baseplate 112 includes a bone-facing side 192 and an oppositesuperior side 194. The bone-facing side 192 is configured to be fixedagainst a resected proximal tibia, for example by bone cement, pressfit, or bone growth onto/into the bone-facing side. The bone-facing side192 may include a distally protruding boss 196 which may include a hole198 to receive a tibial intramedullary stem (not shown). The superiorside 194 is configured to be coupled to the tibial articular insert 110.The superior side 194 may include a locking feature 200 which iscomplementary to the locking feature 186 of the tibial articular insert110, although mobile bearing configurations are also contemplated. Ahole 202 may extend distally into the boss 196. The hole 202 may or maynot intersect the hole 198.

The tibial prosthesis 104 may be assembled by orienting the tibialbaseplate 112 relative to the tibial articular insert 110 as shown inFIG. 2; and coupling the tibial baseplate 112 to the tibial articularinsert 110. Coupling the tibial baseplate 112 to the tibial articularinsert 110 may include engaging the locking features 186, 200 to fix thetibial baseplate 112 to the tibial articular insert 110.

When the tibial prosthesis 104 is assembled, the tibial articular insert110 and the tibial baseplate 112 may be fixed together. The tibialarticular insert 110 may be removably fixed to the tibial baseplate 112.A mobile bearing tibial articular insert is also contemplated, in whichcase the tibial articular insert 110 is free to move relative to thetibial baseplate 112 in use, at least within a limited range of motion.

The knee arthroplasty system 100 may be assembled by orienting thefemoral prosthesis 102 relative to the tibial prosthesis 104 as shown inFIG. 1; and bringing the femoral and tibial prostheses 102, 104 togetherso that the first articular portion 188 of the tibial articular insert110 is against the articular side 116 of the femoral component 106 andthe second articular portion 190 of the tibial articular insert 110 isreceived in the cavity 180 of the adapter 108.

When the knee arthroplasty system 100 is assembled, the tibialprosthesis 104 articulates against the femoral prosthesis 102 to providea range of motion between the tibial and femoral prostheses. The secondarticular portion 190 of the tibial articular insert 110 articulateswithin the cavity 180 of the adapter 108 to modify the nominal range ofmotion that would be possible if the second articular portion 190 wasabsent. The knee arthroplasty system 100 has enhanced stability in usecompared to a design that lacks the CCK constraint features of thesecond articular portion 190 and the cavity 180. More specifically, withreference to FIGS. 11-14, when the knee arthroplasty system 100 is inextension, the tibial prosthesis 104 has limited translation relative tothe femoral prosthesis 102 along directions that are perpendicular tothe axis 103. Specifically, FIG. 12 shows that the tibial prosthesis 104has limited anterior-posterior translation and FIG. 14 shows that thetibial prosthesis has limited medial-lateral translation. With referenceto FIGS. 15 and 16, when the knee arthroplasty system 100 is in flexion,the tibial prosthesis 104 has limited translation along a direction thatis parallel to the axis 103. Specifically, FIG. 16 shows that the tibialprosthesis 104 has limited superior translation. The tibial prosthesis104 also has limited medial-lateral translation in flexion.

With reference to FIGS. 15-18, the adapter 108 is insertable into,fixable within, and removable from the receptacle 124 along a directionthat is parallel to the axis 103, from the distal articular side 116toward the proximal bone-facing side 114, while the femoral prosthesis102 is fixed to a distal femur. The adapter 108 is interchangeable withother distal adapters, such as adapter 308. Adapters can be exchangedbefore or after the femoral component 106 is fixed to the distal femur,even in a subsequent surgery.

A surgical method of implanting the knee arthroplasty system 100 mayinclude some or all of the following steps in any order.

Preparing the distal femur may include making anterior, anteriorchamfer, distal, posterior chamfer, and posterior resections tocomplement the bone-facing side 114 of the femoral component 106;drilling a hole to receive the socket 120, with or without a femoralintramedullary stem (not shown); and/or making a box cut to receive thepedestal 118 and/or adapter 108.

Fixing the femoral component 106 to the distal femur may includeapplying bone cement to the distal femur and/or the bone-facing side 114of the femoral component 106, or press-fitting the femoral component 106to the distal femur. Fasteners may be used to fix the femoral componentto the distal femur.

Fixing the adapter 108 to the femoral component 106 may include flexingthe knee; sliding the adapter into the receptacle 124 from distal toproximal; sliding the medial and lateral protrusions 170, 172 into themedial and lateral slots 148, 150; and fixing the adapter to the femoralcomponent. Fasteners may be used to fix the adapter to the femoralcomponent.

Preparing the proximal tibia may include making a proximal tibialresection to complement the bone-facing side 192 of the tibial baseplate112; and drilling a hole to receive the boss 196, with or without atibial intramedullary stem (not shown).

Fixing the tibial baseplate 112 to the proximal tibia may includeapplying bone cement to the proximal tibia and/or the bone-facing side192 of the tibial baseplate 112, or press-fitting the tibial baseplate112 to the proximal tibia. Fasteners may be used to fix the tibialbaseplate to the proximal tibia.

Coupling the tibial articular insert 110 to the tibial baseplate mayinclude fixing the tibial articular insert to the tibial baseplate, orengaging mobile bearing features of the tibial articular insert and thetibial baseplate.

A surgical method of revising the knee arthroplasty system 100 mayinclude some or all of the following steps in any order. Placing apreviously-operated knee joint in flexion; exposing the adapter 108;releasing the adapter from fixation to the femoral component 106;removing the adapter from the receptacle along a proximal-to-distaldirection; inserting a different adapter into the receptacle along adistal-to-proximal direction; fixing the different adapter to thefemoral component 106; and closing the incision. The tibial articularinsert 110 may be disconnected from the tibial baseplate 112 tofacilitate access to the adapter 108, and optionally reconnected afterthe different adapter has been fixed to the femoral component. Thetibial articular insert 110 may be replaced with a different tibialarticular insert during the same revision surgical procedure, forexample to convert between CCK and hinged or fixed and mobile designs.

Referring to FIGS. 19 and 20, another tibial articular insert 210 foruse in the knee arthroplasty system 100 is shown. The tibial articularinsert 210 may be referred to as a mobile bearing design, and may beused interchangeably with the fixed tibial articular insert 110. Thetibial articular insert 210 includes a bone-facing side 282 and anopposite articular side 284. The bone-facing side 282 is configured tobe coupled to the tibial baseplate 112. The bone-facing side may includea mobile bearing feature 286 to permit limited translation and/orrotation of the tibial articular insert 210 relative to the tibialbaseplate 112. The mobile bearing feature 286 in this example is adistal protrusion whose outer periphery is complementary to, and smallerthan, the profile of the locking feature 200 of the tibial baseplate 112(FIG. 9). The tibial articular insert 210 may also include a distal post292 which extends distally from a central region of the bone-facingside. The post 292 may be referred to as a second mobile bearingfeature. The articular side 284 may include a first articular portion288 for articulation against the articular side 116 of the femoralcomponent 106. The first articular portion 288 may replicate the naturalmedial and lateral tibial articular condyles. The articular side 284 mayalso include a second articular portion 290, which may protrudeproximally from the first articular portion 288. The second articularportion 290 may be referred to as a constraint feature. The secondarticular portion 290 in this example is for articulation within thecavity 180 of the adapter 108. The first and second articular portions288, 290 may be identical to the first and second articular portions188, 190 of the tibial articular insert 110.

Referring to FIGS. 21-38, another knee arthroplasty system 300 mayinclude a femoral prosthesis 302 and/or a tibial prosthesis 304. Thisembodiment may be referred to as a distal hinged fixed design. A leftknee design is shown. The femoral prosthesis 302 may include the femoralcomponent 106 and an adapter 308. The adapter 308 may be a sub-assemblyof multiple parts. The femoral prosthesis 302 may include additionalcomponents, such as a femoral intramedullary stem (not shown) ordefect-filling augments (not shown). Referring to FIGS. 31-34, axis 303corresponds to the femoral mechanical axis. The tibial prosthesis 304may include a tibial articular insert 310 and the tibial baseplate 112,or the tibial articular insert and tibial baseplate may be integrallyformed as a single component. The tibial prosthesis 304 may includeadditional components, such as an intramedullary stem (not shown) ordefect-filling augments (not shown).

Referring to FIG. 22, the adapter 308 may include an adapter body 312, asleeve 314, a post 316, and a pin 318. The adapter 308 is received inthe receptacle 124 of the femoral component 106 along a direction fromthe articular side 116 toward the bone-facing side 114. This means thatthe adapter 308 may be inserted into, fixed within, and removed from thereceptacle 124 while the femoral component 106 is fixed to the distalfemur, during the initial surgical procedure or during a subsequentsurgical procedure. In this example, the adapter 308 is inserted along adistal-to-proximal direction parallel to the axis 303. However, theadapter 308 may be inserted along other directions, such asanterior-to-posterior perpendicular to the axis 303 as discussed below,or along oblique directions, such as distal-anterior toproximal-posterior at a 45 degree angle to the axis 303. The adapterinsertion direction may be based upon the particular characteristics ofthe joint and arthroplasty prosthesis.

The adapter body 312 has an exterior shape which is complementary to theshape of the receptacle 124. Referring to FIG. 37, the adapter body 312has a non-circular exterior cross-sectional shape perpendicular to theaxis 303. A substantially rectangular cross-sectional shape is shown,although any shape that resists rotation about the axis 303 may be used.Referring to FIGS. 23-24, in this example, the adapter body 312 hasplanar medial and lateral walls 352, 354, a planar superior wall 356with an arcuate anterior border 358, and a planar posterior wall 360with medial and lateral posterior ridges 362, 364 that are shownextending parallel to the axis 303. The distal and anterior aspects areopen. This example also includes medial and lateral anterior ridges 366,368 so that together, the medial posterior and anterior ridges 362, 366form a medial undercut rail, and the lateral posterior and anteriorridges 364, 368 form a lateral undercut rail. Examples of undercut railsinclude dovetail rails, T-rails, and the like. The adapter body 312 mayinclude one or more insertion stop features which prevent over-insertionof the adapter into the receptacle 124. The superior ends of the medialand lateral posterior ridges 362, 364 may function as insertion stopsagainst the medial and lateral posterior-superior insertion stopfeatures 142, 144 of the femoral component 106, and the superior wall356 in the vicinity of the arcuate anterior border 358 may function asan insertion stop against the inferior side of the socket 120. Theadapter body 312 may include medial and lateral protrusions 370, 372which extend outwardly medially from the medial wall 352 and laterallyfrom the lateral wall 354, respectively. The superior sides of theprotrusions 370, 372 may function as insertion stops against thesuperior walls of the slots 148, 150. The protrusions 370, 372 mayinclude through holes 374, 376 which extend along a superior-inferiordirection. The holes 374, 376 may receive fasteners (not shown). A hole378 may extend through the superior wall 356 along the superior-inferiordirection. The hole 378 may engage an adapter insertion and/or removaltool (not shown). The walls 352, 354, 356, 360 define an interior cavity380 or space, which may be substantially rectangular. The cavity 380 maybe referred to as a constraint feature. A hole 350 may extend throughthe adapter body 312 along a medial-lateral direction to establish ahinge axis 351 which is perpendicular to the axis 303. The hole 350receives the pin 318.

Referring to FIGS. 25-26, the sleeve 314 includes a superior-inferiorthrough bore 320, which may include a superior counterbore 322. The bore320 and/or counterbore 322 may include internal threads or other meansto fix the head 326 of the post 316 to the sleeve 314. The sleeve 314also includes a medial-lateral through hole 324 which is posterior tothe bore 320 and counterbore 322. The hole 324 receives the pin 318.

Referring to FIGS. 27-28, the post 316 includes a proximal head 326 anda distal shaft 328. The head 326 may be externally threaded to engageinternal threads of the sleeve 314, and may include a torque fitting330, such as the hex socket shown. The distal tip of the shaft 328 maytaper to a blunt distal end.

The adapter 308 may be assembled by orienting the sleeve 314 relative tothe adapter body 312 as shown in FIG. 22; inserting the sleeve into thecavity 380 so that the holes 350, 324 are aligned and the holes 378, 320are aligned; inserting the pin 318 through the holes 350, 324 so thatthe sleeve 314 is free to rotate relative to the adapter body 312 aboutthe hinge axis 351; orienting the post 316 relative to the sleeve 314 asshown in FIG. 22; and fixing the head 326 of the post 316 in the bore320 and/or counterbore 322 of the sleeve 314 so that the shaft 328 ofthe post 316 protrudes distally from the bore 320. The adapter 308 maybe provided in a partially assembled state with the adapter body 312,the sleeve 314, and the pin 318 coupled together, with the step offixing the head 326 of the post 316 in the bore 320 and/or counterbore322 of the sleeve 314 performed during the surgical procedure.

When the adapter 308 is assembled, the fixed-together sleeve 314 andpost 316 are free to rotate relative to the adapter body 312 about thehinge axis 351.

The femoral prosthesis 302 may be assembled by orienting the adapterbody 312 relative to the femoral component 106 as shown in FIG. 22, theadapter body 312 preferably coupled to at least the sleeve 314 and thepin 318; sliding the adapter body into the receptacle 124; sliding themedial and lateral protrusions 370, 372 into the medial and lateralslots 148, 150 until at least one adapter insertion stop featurecontacts a femoral component insertion stop feature; fixing the adapterbody to the femoral component; orienting the post 316 relative to thesleeve 314 as shown in FIG. 22; and fixing the head 326 of the post 316in the bore 320 and/or counterbore 322 of the sleeve 314 so that theshaft 328 of the post 316 protrudes distally from the bore 320. Theadapter body 312 may slide into the receptacle 124 along a directionfrom the articular side 116 toward the bone-facing side 114, which inthis example is from distal to proximal. The protrusions 370, 372 mayslide into the slots 148, 150 along the same direction. The adapter body312 may be fixed to the femoral component 106 by inserting fasteners(not shown) through the holes 374, 376 of the protrusions 370, 372 andinto the superior walls of the slots 148, 150. The protrusions 370, 372,holes 374, 376, and slots 148, 150 may thus be referred to as removalstop features which prevent unintentional removal of the adapter 308from the receptacle, in combination with the fasteners. The removal stopfeatures may be disengaged by removing the fasteners. The step of fixingthe head 326 of the post 316 in the bore 320 and/or counterbore 322 ofthe sleeve 314 may be performed during surgery after the tibialbaseplate 112 has been fixed to the resected proximal tibia.

When the femoral prosthesis 302 is assembled, the femoral component 106and the adapter body 312 are fixed together, and the sleeve 314 and post316 (if attached) are free to rotate relative to the adapter body 312about the hinge axis 351. The adapter body 312 is insertable into,fixable within, and removable from the receptacle 124 when the femoralprosthesis 302 is fixed to a distal femur. The adapter 308 isinterchangeable with other distal adapters, such as adapter 108.

The tibial articular insert 310 includes a bone-facing side 382 and anopposite articular side 384. The bone-facing side 382 is configured tobe coupled to the tibial baseplate 112, and may be referred to as abaseplate-facing side or a distal side. The bone-facing side 382 mayinclude a locking feature 386 to fix the tibial articular insert 310 tothe tibial baseplate 112, although mobile bearing configurations arealso contemplated. Referring briefly to FIGS. 19 and 20, the mobilebearing features 286, 292 of the tibial articular insert 210 may beincluded in tibial articular insert 310 instead of the locking feature386. The articular side 384 may include a first articular portion 388for articulation against the articular side 116 of the femoral component106. The first articular portion 388 may replicate the natural medialand lateral tibial articular condyles. The articular side 384 may alsoinclude a second articular portion 390, which in this example may be ahole that extends through the tibial articular insert 310 between thebone-facing side 382 and the articular side 384 along asuperior-inferior direction. The second articular portion 390 may bereferred to as a constraint feature. The second articular portion 390 inthis example is for articulation with the shaft 328 of the post 316 ofthe adapter 308.

The tibial prosthesis 304 may be assembled by orienting the tibialbaseplate 112 relative to the tibial articular insert 310 as shown inFIG. 22; and coupling the tibial baseplate 112 to the tibial articularinsert 310. Coupling the tibial baseplate 112 to the tibial articularinsert 310 may include engaging the locking features 386, 200 to fix thetibial baseplate 112 to the tibial articular insert 310. The holes 202,390 may be aligned when the tibial prosthesis 304 is assembled.

When the tibial prosthesis 304 is assembled, the tibial articular insert310 and the tibial baseplate 112 may be fixed together. The tibialarticular insert 310 may be removably fixed to the tibial baseplate 112.A mobile bearing tibial articular insert is also contemplated, in whichcase the tibial articular insert 310 is free to move relative to thetibial baseplate 112 in use, at least within a limited range of motion.[00122] The knee arthroplasty system 300 may be assembled by orientingthe femoral prosthesis 302 relative to the tibial prosthesis 304 asshown in FIG. 21; and bringing the femoral and tibial prostheses 302,304 together so that the first articular portion 388 of the tibialarticular insert 310 is against the articular side 116 of the femoralcomponent 106 and the second articular portion 390 of the tibialarticular insert 310 receives the shaft 328 of the post 316 of theadapter 308. Preferably, the post 316 is fixed to the sleeve 314 andinserted through the hole 390 into the hole 202 at this time. Morespecifically, with the knee in flexion, the distal end of the shaft 328of the post 316 may be inserted from proximal to distal through thecounterbore 322, the bore 320, and the hole 390, and into the hole 202;and the head 326 of the post 316 may be fixed in the counterbore 322and/or bore 320.

When the knee arthroplasty system 300 is assembled, the tibialprosthesis 304 articulates against the femoral prosthesis 302 to providea range of motion between the tibial and femoral prostheses. The secondarticular portion 390 of the tibial articular insert 310 articulateswith the shaft 328 of the adapter 308 to modify the nominal range ofmotion that would be possible if the second articular portion 390 and/orpost 316 were absent. The knee arthroplasty system 300 has enhancedstability in use compared to a design that lacks the hinge constraintfeatures of the second articular portion 390 and the post 316. Morespecifically, with reference to FIGS. 31-34, when the knee arthroplastysystem 300 is in extension, the tibial prosthesis 304 has little to notranslation relative to the femoral prosthesis 302 along directions thatare perpendicular to the axis 303. Specifically, FIG. 32 shows that thetibial prosthesis 304 has little to no anterior-posterior translationand FIG. 34 shows that the tibial prosthesis has little to nomedial-lateral translation. With reference to FIGS. 35 and 36, when theknee arthroplasty system 300 is in flexion, the tibial prosthesis 304has little to no translation along a direction that is parallel to theaxis 303. Specifically, FIG. 36 shows that the tibial prosthesis 304 haslittle to no superior translation. The tibial prosthesis 304 also haslittle to no medial-lateral translation in flexion.

With reference to FIGS. 35-38, the adapter 308 is insertable into,fixable within, and removable from the receptacle 124 along a directionthat is parallel to the axis 303, from the distal articular side 116toward the proximal bone-facing side 114, while the femoral prosthesis302 is fixed to a distal femur. The adapter 308 is interchangeable withother distal adapters, such as adapter 108. Adapters can be exchangedbefore or after the femoral component 106 is fixed to the distal femur,even in a subsequent surgery.

A surgical method of implanting the knee arthroplasty system 300 mayinclude some or all of the following steps in any order.

Preparing the distal femur may include making anterior, anteriorchamfer, distal, posterior chamfer, and posterior resections tocomplement the bone-facing side 114 of the femoral component 106;drilling a hole to receive the socket 120, with or without a femoralintramedullary stem (not shown); and/or making a box cut to receive thepedestal 118 and/or adapter 308.

Fixing the femoral component 106 to the distal femur may includeapplying bone cement to the distal femur and/or the bone-facing side 114of the femoral component 106, or press-fitting the femoral component 106to the distal femur. Fasteners may be used to fix the femoral componentto the distal femur.

Fixing the adapter 308 to the femoral component 106 may include flexingthe knee; sliding the adapter body 312 into the receptacle 124 fromdistal to proximal; sliding the medial and lateral protrusions 370, 372into the medial and lateral slots 148, 150; and fixing the adapter bodyto the femoral component. Fasteners may be used to fix the adapter tothe femoral component. Preferably at this step, the adapter body 312 iscoupled to at least the sleeve 314 and the pin 318.

Preparing the proximal tibia may include making a proximal tibialresection to complement the bone-facing side 192 of the tibial baseplate112; and drilling a hole to receive the boss 196, with or without atibial intramedullary stem (not shown).

Fixing the tibial baseplate 112 to the proximal tibia may includeapplying bone cement to the proximal tibia and/or the bone-facing side192 of the tibial baseplate 112, or press-fitting the tibial baseplate112 to the proximal tibia. Fasteners may be used to fix the tibialbaseplate to the proximal tibia.

Coupling the tibial articular insert 310 to the tibial baseplate mayinclude fixing the tibial articular insert to the tibial baseplate, orengaging mobile bearing features of the tibial articular insert and thetibial baseplate.

A surgical method of revising the knee arthroplasty system 300 mayinclude some or all of the following steps in any order. Placing apreviously-operated knee joint in flexion; exposing the adapter 308;releasing the post 316 from fixation to the sleeve 314; removing thepost 316 from the holes 202, 390, bore 320, and counterbore 322;releasing the adapter body 312 from fixation to the femoral component106; removing the adapter body from the receptacle along aproximal-to-distal direction; inserting a different adapter into thereceptacle along a distal-to-proximal direction; fixing the differentadapter to the femoral component 106; and closing the incision. Thetibial articular insert 310 may be disconnected from the tibialbaseplate 112 to facilitate access to the adapter 308, and optionallyreconnected after the different adapter has been fixed to the femoralcomponent. The tibial articular insert 310 may be replaced with adifferent tibial articular insert during the same revision surgicalprocedure, for example to convert between CCK and hinged or fixed andmobile designs.

Referring to FIGS. 39-50, yet another knee arthroplasty system 400 mayinclude a femoral prosthesis 402 and/or the tibial prosthesis 104. Thisembodiment may be referred to as an anterior CCK fixed design. A leftknee design is shown. The femoral prosthesis 402 may include a femoralcomponent 406 and an adapter 408. The femoral prosthesis 402 may includeadditional components, such as a femoral intramedullary stem (not shown)or defect-filling augments (not shown). Referring to FIGS. 45-48, axis403 corresponds to the femoral mechanical axis.

The femoral component 406 includes a bone-facing side 414 and anopposite articular side 416. The bone-facing side 414 is configured tobe fixed against a resected distal femur, for example by bone cement,press fit, or bone growth onto/into the bone-facing side. Thebone-facing side 414 may include multiple portions corresponding toconventional anterior, anterior chamfer, distal, posterior chamfer,and/or posterior femoral resections. The bone-facing side 414 mayinclude a pedestal 418 and/or a socket 420. The pedestal 418 in thisexample is a rectangular feature that protrudes superiorly from thesurrounding bone-facing side. The pedestal 418 provides structuralsupport for the socket 420, which protrudes superiorly from the superioraspect of the pedestal. The socket 420 may include a hole 422 to receivea femoral intramedullary stem (not shown). Referring to FIG. 48, thesocket 420 and hole 422 are shown oriented along a generallysuperior-inferior axis 407 which may correspond to the femoralanatomical axis, also referred to as the femoral shaft axis. Thearticular side 416 is configured to articulate against a complementaryarticular side 184 of the tibial prosthesis 104, or against a naturalarticular surface of the proximal tibia. The articular side 416 may wraparound the anterior, distal, and posterior aspects of the femoralcomponent 406 to replicate some or all of the natural articular surfacesof the distal femur.

The femoral component 406 includes a receptacle 424, or space or alcove,which extends posteriorly into the anterior aspect of the femoralcomponent between the medial and lateral condyles 426, 428. Thereceptacle 424 receives the adapter 408 or the adapter 508. Referring toFIG. 46, the receptacle 424 is shown extending along a direction that isperpendicular to the axis 403. Referring to FIG. 49, the receptacle 424has a non-circular cross-sectional shape parallel to the axis 403 in theanterior view. A substantially rectangular cross-sectional shape isshown, although any shape that resists rotation may be used. Morespecifically, in this example, the receptacle 424 has planar medial andlateral walls 430, 432, planar posterior and superior walls 434, 435 andsubstantially open distal and anterior aspects 436, 437. Medial andlateral proximal grooves 438, 440 are shown extending perpendicular tothe axis 403. Together, the medial and lateral proximal grooves 438, 440form a proximal undercut channel; a distal undercut channel may also bepresent. Examples of undercut channels include dovetail channels,T-slots, and the like. The receptacle 424 may include a second pair ofmedial and lateral grooves 442, 444 which extend perpendicular to theaxis 403, distal and parallel to the medial and lateral proximal grooves438, 440. A window 446 may extend through the medial and lateral walls430, 432 and intersect the posterior ends of the grooves 442, 444. Thereceptacle 424 may include one or more insertion stop features whichprevent over-insertion of the adapter 408 or 508 into the receptacle. Inthis example, the posterior wall 434 may function as an insertion stop.The receptacle 424 may include one or more removal stop features whichprevent unintentional removal of the adapter from the receptacle. Theanterior walls of the window 446 on either side of the grooves 442, 444may function as removal stops. Medial proximal and distal removal stops448, 449 and lateral distal removal stop 450 are visible in FIGS. 41-42;a lateral proximal removal stop is hidden from view in FIG. 41.

The adapter 408 is received in the receptacle 424 of the femoralcomponent 406 along a direction from the articular side 416 toward thebone-facing side 414. This means that the adapter 408 may be insertedinto, fixed within, and removed from the receptacle 424 while thefemoral component 406 is fixed to the distal femur, during the initialsurgical procedure or during a subsequent surgical procedure. In thisexample, the adapter 408 is inserted along an anterior-to-posteriordirection perpendicular to the axis 403. However, the adapter 408 may beinserted along other directions, such as distal-to-proximal parallel tothe axis 403 as discussed above, or along oblique directions, such asdistal-anterior to proximal-posterior at a 45 degree angle to the axis403. The adapter insertion direction may be based upon the particularcharacteristics of the joint and arthroplasty prosthesis.

The adapter 408 has an exterior shape which is complementary to theshape of the receptacle 424. Referring to FIG. 49, the adapter 408 has anon-circular exterior cross-sectional shape parallel to the axis 403 inthe anterior view. A substantially rectangular cross-sectional shape isshown, although any shape that resists rotation may be used. Morespecifically, in this example, the adapter 408 has planar medial andlateral walls 452, 454, a planar superior wall 456, and a planarposterior wall 460. Referring to FIGS. 43, 44, and 46, an anterior wall458 may be present; its exterior anterior aspect may blend with thetrochlear groove of the articular side 416 of the femoral component 406.The distal aspect is open. Medial and lateral proximal ridges 462, 464are shown extending perpendicular to the axis 403. Together, the medialand lateral proximal ridges 462, 464 form a proximal undercut rail; adistal undercut rail may also be present. Examples of undercut railsinclude dovetail rails, T-rails, and the like. The medial and lateralwalls 452, 454 may include medial and lateral arms 466, 468,respectively. The posterior ends of the arms 466, 468 may be integrallyformed with the walls 452, 454, while the proximal, anterior, and distalsides of the arms 466, 468 may be separated from the walls 452, 454 by aU-shaped slit 470, or window, that extends through the medial andlateral walls 452, 454. Each arm 466, 468 may angle outwardly fromposterior to anterior, so that the anterior free ends of the arms 466,468 protrude outwardly from the walls 452, 454. The medial and lateralarms 466, 468 may include medial and lateral exterior grooves 472, 474which may be deepest at the anterior ends of the arms, becomingshallower toward the posterior ends of the arms. The adapter 408 mayinclude one or more insertion stop features which prevent over-insertionof the adapter into the receptacle 424. The posterior wall 460 mayfunction as an insertion stop against the posterior wall 434 of thefemoral component 406. The adapter 408 may include one or more removalstop features which prevent unintentional removal of the adapter fromthe receptacle 424. The anterior ends of the arms 466, 468 on eitherside of the grooves 472, 474 may function as removal stops. Medialproximal and distal removal stops 476, 477 are shown in FIG. 43 andlateral proximal and distal removal stops 478, 479 are shown in FIG. 44.The walls 452, 454, 456, 458, 460 define an interior cavity 480 orspace, which may be substantially rectangular. The cavity 480 may bereferred to as a constraint feature. The cavity 480 may include a camfor interaction with the second articular portion 190 of the tibialarticular insert 110, described above.

The femoral prosthesis 402 may be assembled by orienting the adapter 408relative to the femoral component 406 as shown in FIG. 40; sliding theadapter into the receptacle 424 until at least one adapter insertionstop feature contacts a femoral component insertion stop feature; andfixing the adapter to the femoral component. The adapter 408 may slideinto the receptacle 424 along a direction from the articular side 416toward the bone-facing side 414, which in this example is from anteriorto posterior. The arms 466, 468 may be elastically deformed inwardly asthe adapter 408 enters the receptacle 424, and may spring outwardly tooccupy the window 446 as the adapter is fully seated in the receptacle.The adapter 408 may be fixed to the femoral component 406 by the arms466, 468 in the window 446. More specifically, the medial proximalremoval stop features 448, 476; the medial distal removal stop features449, 477; the lateral proximal removal stop features (femoral hidden),478; and/or the lateral distal removal stop features 450, 479 may becomeengaged to fix the adapter to the femoral component. The removal stopfeatures may be disengaged by inserting a tool into the grooves 442, 472and/or 444, 474 to press the arms 466, 468 inwardly. For example, thetool may resemble a tuning fork with a pair of protruding prongs.

When the femoral prosthesis 402 is assembled, the femoral component 406and the adapter 408 are fixed together. The adapter 408 is insertableinto, fixable within, and removable from the receptacle 424 when thefemoral prosthesis 402 is fixed to a distal femur. The adapter 408 isinterchangeable with other anterior adapters, such as adapter 508discussed below.

The knee arthroplasty system 400 may be assembled by orienting thefemoral prosthesis 402 relative to the tibial prosthesis 104 as shown inFIG. 39; and bringing the femoral and tibial prostheses 402, 104together so that the first articular portion 188 of the tibial articularinsert 110 is against the articular side 416 of the femoral component406 and the second articular portion 190 of the tibial articular insert110 is received in the cavity 480 of the adapter 408.

When the knee arthroplasty system 400 is assembled, the tibialprosthesis 104 articulates against the femoral prosthesis 402 to providea range of motion between the tibial and femoral prostheses. The secondarticular portion 190 of the tibial articular insert 110 articulateswithin the cavity 480 of the adapter 408 to modify the nominal range ofmotion that would be possible if the second articular portion 190 wasabsent. The knee arthroplasty system 400 has enhanced stability in usecompared to a design that lacks the CCK constraint features of thesecond articular portion 190 and the cavity 480. More specifically, withreference to FIGS. 45-48, when the knee arthroplasty system 400 is inextension, the tibial prosthesis 104 has limited translation relative tothe femoral prosthesis 402 along directions that are perpendicular tothe axis 403. Specifically, FIG. 46 shows that the tibial prosthesis 104has limited anterior-posterior translation and FIG. 48 shows that thetibial prosthesis has limited medial-lateral translation. As shown inFIGS. 15 and 16 for knee arthroplasty system 100, when the kneearthroplasty system 400 is in flexion, the tibial prosthesis 104 haslimited translation along a direction that is parallel to the axis 403.Specifically, FIG. 16 shows that the tibial prosthesis 104 has limitedsuperior translation. The tibial prosthesis 104 also has limitedmedial-lateral translation in flexion.

With reference to FIGS. 49-50, the adapter 408 is insertable into,fixable within, and removable from the receptacle 424 along ananterior-posterior direction that is perpendicular to the axis 403, fromthe anterior articular side 416 toward the posterior bone-facing side414, while the femoral prosthesis 402 is fixed to a distal femur. Theadapter 408 is interchangeable with other anterior adapters, such asadapter 508. Adapters can be exchanged before or after the femoralcomponent 406 is fixed to the distal femur, even in a subsequentsurgery.

A surgical method of implanting the knee arthroplasty system 400 mayinclude some or all of the following steps in any order.

Preparing the distal femur may include making anterior, anteriorchamfer, distal, posterior chamfer, and posterior resections tocomplement the bone-facing side 414 of the femoral component 406;drilling a hole to receive the socket 420, with or without a femoralintramedullary stem (not shown); and/or making a box cut to receive thepedestal 418 and/or adapter 408.

Fixing the femoral component 406 to the distal femur may includeapplying bone cement to the distal femur and/or the bone-facing side 414of the femoral component 406, or press-fitting the femoral component 406to the distal femur. Fasteners may be used to fix the femoral componentto the distal femur.

Fixing the adapter 408 to the femoral component 406 may includeextending or flexing the knee; sliding the adapter into the receptacle424 from anterior to posterior; sliding the medial and lateral arms 466,468 into the window 446; and fixing the adapter to the femoralcomponent. Optional fasteners may be used to fix the adapter to thefemoral component.

Preparing the proximal tibia may include making a proximal tibialresection to complement the bone-facing side 192 of the tibial baseplate112; and drilling a hole to receive the boss 196, with or without atibial intramedullary stem (not shown).

Fixing the tibial baseplate 112 to the proximal tibia may includeapplying bone cement to the proximal tibia and/or the bone-facing side192 of the tibial baseplate 112, or press-fitting the tibial baseplate112 to the proximal tibia. Fasteners may be used to fix the tibialbaseplate to the proximal tibia.

Coupling the tibial articular insert 110 to the tibial baseplate mayinclude fixing the tibial articular insert to the tibial baseplate, orengaging mobile bearing features of the tibial articular insert and thetibial baseplate.

A surgical method of revising the knee arthroplasty system 400 mayinclude some or all of the following steps in any order. Placing apreviously-operated knee joint in extension or flexion; exposing theadapter 408; releasing the adapter from fixation to the femoralcomponent 406; removing the adapter from the receptacle along aposterior-to-anterior direction; inserting a different adapter into thereceptacle along an anterior-to-posterior direction; fixing thedifferent adapter to the femoral component 406; and closing theincision. The tibial articular insert 110 may be disconnected from thetibial baseplate 112 to facilitate access to the adapter 408, andoptionally reconnected after the different adapter has been fixed to thefemoral component. The tibial articular insert 110 may be replaced witha different tibial articular insert during the same revision surgicalprocedure, for example to convert between CCK and hinged or fixed andmobile designs.

Referring to FIGS. 51-60, yet another knee arthroplasty system 500 mayinclude a femoral prosthesis 502 and/or the tibial prosthesis 304. Thisembodiment may be referred to as an anterior hinged fixed design. A leftknee design is shown. The femoral prosthesis 502 may include the femoralcomponent 406 and an adapter 508. The adapter 508 may be a sub-assemblyof multiple parts. The femoral prosthesis 502 may include additionalcomponents, such as a femoral intramedullary stem (not shown) ordefect-filling augments (not shown). Referring to FIGS. 55-58, axis 503corresponds to the femoral mechanical axis.

Referring to FIG. 52, the adapter 508 may include an adapter body 512,the sleeve 314, the post 316, and the pin 318. The adapter 508 isreceived in the receptacle 424 of the femoral component 406 along adirection from the articular side 416 toward the bone-facing side 414.This means that the adapter 508 may be inserted into, fixed within, andremoved from the receptacle 424 while the femoral component 406 is fixedto the distal femur, during the initial surgical procedure or during asubsequent surgical procedure. In this example, the adapter 508 isinserted along an anterior-to-posterior direction perpendicular to theaxis 503. However, the adapter 508 may be inserted along otherdirections, such as distal-to-proximal parallel to the axis 503 asdiscussed above, or along oblique directions, such as distal-anterior toproximal-posterior at a 45 degree angle to the axis 503. The adapterinsertion direction may be based upon the particular characteristics ofthe joint and arthroplasty prosthesis.

The adapter body 512 has an exterior shape which is complementary to theshape of the receptacle 424. Referring to FIG. 59, the adapter body 512has a non-circular exterior cross-sectional shape parallel to the axis503 in the anterior view. A substantially rectangular cross-sectionalshape is shown, although any shape that resists rotation may be used.More specifically, in this example, the adapter 508 has planar medialand lateral walls 552, 554, a planar superior wall 556, and a planarposterior wall 560. Referring to FIGS. 53-56, an anterior wall 558 maybe present; its exterior anterior aspect may blend with the trochleargroove of the articular side 416 of the femoral component 406. Thedistal aspect is open. Medial and lateral proximal ridges 562, 564 areshown extending perpendicular to the axis 503. Together, the medial andlateral proximal ridges 562, 564 form a proximal undercut rail; a distalundercut rail may also be present. Examples of undercut rails includedovetail rails, T-rails, and the like. The medial and lateral walls 552,554 may include medial and lateral arms 566, 568, respectively. Theposterior ends of the arms 566, 568 may be integrally formed with thewalls 552, 554, while the proximal, anterior, and distal sides of thearms 566, 568 may be separated from the walls 552, 554 by a U-shapedslit 570, or window, that extends through the medial and lateral walls552, 554. Each arm 566, 568 may angle outwardly from posterior toanterior, so that the anterior free ends of the arms 566, 568 protrudeoutwardly from the walls 552, 554. The medial and lateral arms 566, 568may include medial and lateral exterior grooves 572, 574 which may bedeepest at the anterior ends of the arms, becoming shallower toward theposterior ends of the arms. The adapter 508 may include one or moreinsertion stop features which prevent over-insertion of the adapter intothe receptacle 424. The posterior wall 560 may function as an insertionstop against the posterior wall 434 of the femoral component 406. Theadapter 508 may include one or more removal stop features which preventunintentional removal of the adapter from the receptacle 424. Theanterior ends of the arms 566, 568 on either side of the grooves 572,574 may function as removal stops. Medial proximal and distal removalstops 576, 577 are shown in FIG. 53 and lateral proximal and distalremoval stops 578, 579 are shown in FIG. 54. The walls 552, 554, 556,568, 560 define an interior cavity 580 or space, which may besubstantially rectangular. The cavity 580 may be referred to as aconstraint feature. A hole 550 may extend through the adapter body 512along a medial-lateral direction to establish a hinge axis 551 which isperpendicular to the axis 503. The hole 550 receives the pin 318.

The adapter 508 may be assembled by orienting the sleeve 314 relative tothe adapter body 512 as shown in FIG. 52; inserting the sleeve into thecavity 580 so that the holes 550, 324 are aligned; inserting the pin 318through the holes 550, 324 so that the sleeve 314 is free to rotaterelative to the adapter body 512 about the hinge axis 551; orienting thepost 316 relative to the sleeve 314 as shown in FIG. 52; and fixing thehead 326 of the post 316 in the bore 320 and/or counterbore 322 of thesleeve 314 so that the shaft 328 of the post 316 protrudes distally fromthe bore 320. The adapter 508 may be provided in a partially assembledstate with the adapter body 512, the sleeve 314, and the pin 318 coupledtogether, with the step of fixing the head 326 of the post 316 in thebore 320 and/or counterbore 322 of the sleeve 314 performed during thesurgical procedure.

When the adapter 508 is assembled, the fixed-together sleeve 314 andpost 316 are free to rotate relative to the adapter body 512 about thehinge axis 551.

The femoral prosthesis 502 may be assembled by orienting the adapterbody 512 relative to the femoral component 406 as shown in FIG. 52, theadapter body 512 preferably coupled to at least the sleeve 314 and thepin 318; sliding the adapter body into the receptacle 424 until at leastone adapter insertion stop feature contacts a femoral componentinsertion stop feature; fixing the adapter body to the femoralcomponent; orienting the post 316 relative to the sleeve 314 as shown inFIG. 52; and fixing the head 326 of the post 316 in the bore 320 and/orcounterbore 322 of the sleeve 314 so that the shaft 328 of the post 316protrudes distally from the bore 320. The adapter body 512 may slideinto the receptacle 424 along a direction from the articular side 416toward the bone-facing side 414, which in this example is from anteriorto posterior. The arms 566, 568 may be elastically deformed inwardly asthe adapter 508 enters the receptacle 424, and may spring outwardly tooccupy the window 446 as the adapter is fully seated in the receptacle.The adapter 508 may be fixed to the femoral component 406 by the arms566, 568 in the window 446. More specifically, the medial proximalremoval stop features 448, 576; the medial distal removal stop features449, 577; the lateral proximal removal stop features (femoral hidden),578; and/or the lateral distal removal stop features 450, 579 may becomeengaged to fix the adapter to the femoral component. The removal stopfeatures may be disengaged by inserting a tool into the grooves 442, 572and/or 444, 574 to press the arms 566, 568 inwardly. For example, thetool may resemble a tuning fork with a pair of protruding prongs.

When the femoral prosthesis 502 is assembled, the femoral component 406and the adapter body 512 are fixed together, and the sleeve 314 and post316 (if attached) are free to rotate relative to the adapter body 512about the hinge axis 551. The adapter body 512 is insertable into,fixable within, and removable from the receptacle 424 when the femoralprosthesis 502 is fixed to a distal femur. The adapter 508 isinterchangeable with other anterior adapters, such as adapter 408.

The knee arthroplasty system 500 may be assembled by orienting thefemoral prosthesis 502 relative to the tibial prosthesis 304 as shown inFIG. 51; and bringing the femoral and tibial prostheses 502, 304together so that the first articular portion 388 of the tibial articularinsert 310 is against the articular side 416 of the femoral component406 and the second articular portion 390 of the tibial articular insert310 receives the shaft 328 of the post 316 of the adapter 508.Preferably, the post 316 is fixed to the sleeve 314 and inserted throughthe hole 390 into the hole 202 at this time. More specifically, with theknee in flexion, the distal end of the shaft 328 of the post 316 may beinserted from proximal to distal through the counterbore 322, the bore320, and the hole 390, and into the hole 202; and the head 326 of thepost 316 may be fixed in the counterbore 322 and/or bore 320.

When the knee arthroplasty system 500 is assembled, the tibialprosthesis 304 articulates against the femoral prosthesis 502 to providea range of motion between the tibial and femoral prostheses. The secondarticular portion 390 of the tibial articular insert 310 articulateswith the shaft 328 of the adapter 508 to modify the nominal range ofmotion that would be possible if the second articular portion 390 and/orpost 316 were absent. The knee arthroplasty system 500 has enhancedstability in use compared to a design that lacks the hinge constraintfeatures of the second articular portion 390 and the post 316. Morespecifically, with reference to FIGS. 55-58, when the knee arthroplastysystem 500 is in extension, the tibial prosthesis 304 has little to notranslation relative to the femoral prosthesis 502 along directions thatare perpendicular to the axis 503. Specifically, FIG. 56 shows that thetibial prosthesis 304 has little to no anterior-posterior translationand FIG. 58 shows that the tibial prosthesis has little to nomedial-lateral translation. With reference to FIGS. 35 and 36 for kneearthroplasty system 300, when the knee arthroplasty system 500 is inflexion, the tibial prosthesis 304 has little to no translation along adirection that is parallel to the axis 503. Specifically, FIG. 36 showsthat the tibial prosthesis 304 has little to no superior translation.The tibial prosthesis 304 also has little to no medial-lateraltranslation in flexion.

With reference to FIGS. 59-60, the adapter 508 is insertable into,fixable within, and removable from the receptacle 424 along ananterior-posterior direction that is perpendicular to the axis 503, fromthe anterior articular side 416 toward the posterior bone-facing side414, while the femoral prosthesis 502 is fixed to a distal femur. Theadapter 508 is interchangeable with other anterior adapters, such asadapter 408. Adapters can be exchanged before or after the femoralcomponent 406 is fixed to the distal femur, even in a subsequentsurgery.

A surgical method of implanting the knee arthroplasty system 500 mayinclude some or all of the following steps in any order.

Preparing the distal femur may include making anterior, anteriorchamfer, distal, posterior chamfer, and posterior resections tocomplement the bone-facing side 414 of the femoral component 406;drilling a hole to receive the socket 420, with or without a femoralintramedullary stem (not shown); and/or making a box cut to receive thepedestal 418 and/or adapter 508.

Fixing the femoral component 406 to the distal femur may includeapplying bone cement to the distal femur and/or the bone-facing side 414of the femoral component 406, or press-fitting the femoral component 406to the distal femur. Fasteners may be used to fix the femoral componentto the distal femur.

Fixing the adapter 508 to the femoral component 406 may includeextending or flexing the knee; sliding the adapter body 512 into thereceptacle 424 from anterior to posterior; sliding the medial andlateral arms 566, 568 into the window 446; and fixing the adapter bodyto the femoral component. Optional fasteners may be used to fix theadapter to the femoral component. Preferably at this step, the adapterbody 512 is coupled to at least the sleeve 314 and the pin 318.

Preparing the proximal tibia may include making a proximal tibialresection to complement the bone-facing side 192 of the tibial baseplate112; and drilling a hole to receive the boss 196, with or without atibial intramedullary stem (not shown).

Fixing the tibial baseplate 112 to the proximal tibia may includeapplying bone cement to the proximal tibia and/or the bone-facing side192 of the tibial baseplate 112, or press-fitting the tibial baseplate112 to the proximal tibia. Fasteners may be used to fix the tibialbaseplate to the proximal tibia.

Coupling the tibial articular insert 310 to the tibial baseplate mayinclude fixing the tibial articular insert to the tibial baseplate, orengaging mobile bearing features of the tibial articular insert and thetibial baseplate.

A surgical method of revising the knee arthroplasty system 500 mayinclude some or all of the following steps in any order. Placing apreviously-operated knee joint in extension or flexion; exposing theadapter 508; releasing the post 316 from fixation to the sleeve 314;removing the post 316 from the holes 202, 390, bore 320, and counterbore322; releasing the adapter body 512 from fixation to the femoralcomponent 406; removing the adapter body from the receptacle along aposterior-to-anterior direction; inserting a different adapter into thereceptacle along an anterior-to-posterior direction; fixing thedifferent adapter to the femoral component 406; and closing theincision. The tibial articular insert 310 may be disconnected from thetibial baseplate 112 to facilitate access to the adapter 508, andoptionally reconnected after the different adapter has been fixed to thefemoral component. The tibial articular insert 310 may be replaced witha different tibial articular insert during the same revision surgicalprocedure, for example to convert between CCK and hinged or fixed andmobile designs.

Any methods disclosed herein includes one or more steps or actions forperforming the described method. The method steps and/or actions may beinterchanged with one another. In other words, unless a specific orderof steps or actions is required for proper operation of the embodiment,the order and/or use of specific steps and/or actions may be modified.

Reference throughout this specification to “an embodiment” or “theembodiment” means that a particular feature, structure or characteristicdescribed in connection with that embodiment is included in at least oneembodiment. Thus, the quoted phrases, or variations thereof, as recitedthroughout this specification are not necessarily all referring to thesame embodiment.

Similarly, it should be appreciated that in the above description ofembodiments, various features are sometimes grouped together in a singleembodiment, Figure, or description thereof for the purpose ofstreamlining the disclosure. This method of disclosure, however, is notto be interpreted as reflecting an intention that any claim require morefeatures than those expressly recited in that claim. Rather, as thefollowing claims reflect, inventive aspects lie in a combination offewer than all features of any single foregoing disclosed embodiment.Thus, the claims following this Detailed Description are herebyexpressly incorporated into this Detailed Description, with each claimstanding on its own as a separate embodiment. This disclosure includesall permutations of the independent claims with their dependent claims.

Recitation in the claims of the term “first” with respect to a featureor element does not necessarily imply the existence of a second oradditional such feature or element. Elements recited inmeans-plus-function format are intended to be construed in accordancewith 35 U.S.C. § 112 Para. 6. It will be apparent to those having skillin the art that changes may be made to the details of theabove-described embodiments without departing from the underlyingprinciples of the technology.

While specific embodiments and applications of the present technologyhave been illustrated and described, it is to be understood that thetechnology is not limited to the precise configuration and componentsdisclosed herein. Various modifications, changes, and variations whichwill be apparent to those skilled in the art may be made in thearrangement, operation, and details of the methods and systems of thepresent technology disclosed herein without departing from the spiritand scope of the technology.

The invention claimed is:
 1. An arthroplasty system for a joint betweena first bone and a second bone, the arthroplasty system comprising: afirst arthroplasty prosthesis comprising: a first arthroplasty componentconfigured to be fixed to the first bone and comprising an articularside and a receptacle; and a first adapter which is removably fixable inthe receptacle and comprises a constraint feature; wherein the articularside of the first arthroplasty component of the first arthroplastyprosthesis is configured to articulate against a first articular portionof a second arthroplasty prosthesis configured to be fixed to the secondbone, so as to provide a nominal range of motion between the first andsecond arthroplasty prostheses, and the constraint feature of the firstadapter is configured to articulate against a complementary constraintfeature of the second arthroplasty prosthesis to provide a firstconstraint to the nominal range of motion; wherein the arthroplastysystem further comprises a third arthroplasty prosthesis comprising: thefirst arthroplasty component; and a second adapter which is removablyfixable in the receptacle and comprises a constraint feature; whereinthe articular side of the first arthroplasty component of the thirdarthroplasty prosthesis is configured to articulate against a firstarticular portion of a fourth arthroplasty prosthesis configured to befixed to the second bone, so as to provide the nominal range of motionbetween the third and fourth arthroplasty prostheses, and the constraintfeature of the second adapter is configured to articulate against acomplementary constraint feature of the fourth arthroplasty prosthesisto provide a second constraint to the nominal range of motion so that:the second constraint provides greater constraint to the nominal rangeof motion than the first constraint; when the joint is extended, thefourth arthroplasty prosthesis is prevented from translating along adirection that is generally perpendicular to a mechanical axis of thefirst bone; and when the joint is flexed, the fourth arthroplastyprosthesis is prevented from translating along a direction that isgenerally parallel to a mechanical axis of the first bone.
 2. Thearthroplasty system of claim 1, wherein the first and second adaptersare insertable into, fixable within, and removable from the receptaclewhen the first arthroplasty component is fixed to the first bone.
 3. Thearthroplasty system of claim 2, wherein the first and second adapters gointo the receptacle along a direction that is generally parallel to amechanical axis of the first bone when the first arthroplasty componentis fixed to the first bone.
 4. The arthroplasty system of claim 3,wherein the direction that is generally parallel to the mechanical axisof the first bone comprises an angle of 0°±45° to the mechanical axis ofthe first bone.
 5. The arthroplasty system of claim 2, wherein the firstand second adapters go into the receptacle along a direction that isgenerally perpendicular to a mechanical axis of the first bone from agenerally anterior to posterior direction with respect to the first bonewhen the first arthroplasty component is fixed to the first bone;wherein the receptacle extends into the first arthroplasty componentalong the direction, wherein the receptacle comprises a first insertionstop feature and a first removal stop feature, wherein the receptaclecomprises a non-circular cross-sectional shape perpendicular to thedirection; wherein the first and second adapters each comprise anon-circular exterior cross-sectional shape perpendicular to thedirection, a second insertion stop feature, and a second removal stopfeature, wherein the non-circular exterior cross-sectional shape of thefirst and second adapters is complementary to the non-circularcross-sectional shape of the receptacle; wherein when the first andsecond adapters are in the receptacle, the non-circular exteriorcross-sectional shape of the first and second adapters fits closelywithin the non-circular cross-sectional shape of the receptacle, thefirst and second insertion stop features are engaged to preventover-insertion of the first and second adapters into the receptacle, andthe first and second removal stop features are engaged to preventunintentional removal of the first and second adapters out of thereceptacle, wherein the first and second removal stop features aredisengageable.
 6. The arthroplasty system of claim 5, wherein: thedirection that is generally perpendicular to the mechanical axis of thefirst bone comprises an angle within + or −45 degrees from a directionperpendicular to the mechanical axis of the first bone; and thegenerally anterior to posterior direction with respect to the first bonecomprises an angle within + or −45 degrees from an anterior to posteriordirection with respect to the first bone.
 7. The arthroplasty system ofclaim 1, wherein the constraint feature of the first adapter comprises acavity; wherein the complementary constraint feature of the secondarthroplasty prosthesis comprises a protrusion received in the cavity sothat when the joint is extended, the second arthroplasty prosthesis haslimited translation along a direction that is generally perpendicular toa mechanical axis of the first bone, and so that when the joint isflexed, the second arthroplasty prosthesis has limited translation alonga direction that is generally parallel to the mechanical axis of thefirst bone.
 8. The arthroplasty system of claim 1, wherein the secondadapter comprises: a main body; a sleeve coupled to the main body by ahinge so that the sleeve rotates relative to the main body about a hingeaxis, wherein the sleeve comprises a bore; and a shaft that is fixed inthe bore of the sleeve, wherein the constraint feature of the secondadapter comprises the shaft; and wherein the complementary constraintfeature of the fourth arthroplasty prosthesis comprises a hole thatreceives the shaft, so that the shaft rotates within the hole about acentral longitudinal shaft axis and translates within the hole along thecentral longitudinal shaft axis.
 9. An arthroplasty system for a jointbetween a first bone and a second bone, the arthroplasty systemcomprising: a first arthroplasty prosthesis comprising: a firstarthroplasty component configured to be fixed to the first bone, whereinthe first arthroplasty component comprises a receptacle, and wherein thefirst arthroplasty component is configured to articulate against asecond arthroplasty prosthesis which is configured to be fixed to thesecond bone, so as to provide a nominal range of motion between thefirst and second arthroplasty prostheses; a first adapter removablyfixed in the receptacle, wherein the first adapter is insertable intothe receptacle along a direction that is generally perpendicular to amechanical axis of the first bone from a generally anterior to posteriordirection with respect to the first bone when the first arthroplastycomponent is fixed to the first bone, and wherein the first adaptercomprises a first constraint feature that articulates against a secondconstraint feature of the second arthroplasty prosthesis to increasestability of the first arthroplasty prosthesis relative to the secondarthroplasty prosthesis; and a second adapter that is interchangeablewith the first adapter, the second adapter comprising a third constraintfeature for constrained articulation against a fourth constraint featureof the second arthroplasty prosthesis that is interchangeable with thesecond constraint feature.
 10. The arthroplasty system of claim 9,wherein the first adapter is insertable into, fixable within, andremovable from the receptacle when the first arthroplasty component isfixed to the first bone.
 11. The arthroplasty system of claim 9, whereinthe first constraint feature of the first adapter comprises a cavity;wherein the second constraint feature of the second arthroplastyprosthesis comprises a protrusion received in the cavity so that whenthe joint is extended, the second arthroplasty prosthesis has limitedtranslation along a direction that is generally perpendicular to amechanical axis of the first bone, and so that when the joint is flexed,the second arthroplasty prosthesis has limited translation along adirection that is generally parallel to the mechanical axis of the firstbone.
 12. The arthroplasty system of claim 9, wherein the first adaptercomprises: a main body; a sleeve coupled to the main body by a hinge sothat the sleeve rotates relative to the main body about a hinge axis,wherein the sleeve comprises a bore; and a shaft that is fixed in thebore of the sleeve, wherein the first constraint feature of the firstadapter comprises the shaft; and wherein the second constraint featureof the second arthroplasty prosthesis comprises a hole that receives theshaft, so that the shaft rotates within the hole about a centrallongitudinal shaft axis and translates within the hole along the centrallongitudinal shaft axis.
 13. The arthroplasty system of claim 9,wherein: the direction that is generally perpendicular to the mechanicalaxis of the first bone comprises an angle within + or −45 degrees from adirection perpendicular to the mechanical axis of the first bone; andthe generally anterior to posterior direction with respect to the firstbone comprises an angle within + or −45 degrees from an anterior toposterior direction with respect to the first bone.
 14. The arthroplastysystem of claim 9, wherein the first constraint feature of the firstadapter and the second constraint feature of the second arthroplastyprosthesis form a constrained condylar knee prosthesis that provides afirst constraint to the nominal range of motion.
 15. The arthroplastysystem of claim 14, wherein the third constraint feature of the secondadapter and the fourth constraint feature of the second arthroplastyprosthesis form a hinged knee prosthesis that provides a secondconstraint to the nominal range of motion, wherein the second constraintprovides greater constraint to the nominal range of motion than thefirst constraint.
 16. An arthroplasty system for a joint between a firstbone and a second bone, the arthroplasty system comprising: a firstarthroplasty prosthesis comprising: a first arthroplasty component witha receptacle, wherein the first arthroplasty component is configured tobe fixed to the first bone and to articulate against a secondarthroplasty prosthesis which is configured to be fixed to the secondbone, so as to provide a nominal range of motion between the first andsecond arthroplasty prostheses; a first adapter removably fixable in thereceptacle, wherein the first adapter comprises: a first constraintfeature for constrained articulation against a second constraint featureof the second arthroplasty prosthesis to modify the nominal range ofmotion; a main body; and a sleeve coupled to the main body by a hinge,so that the main body rotates relative to the sleeve about a hinge axis,wherein the first constraint feature comprises a shaft coupled to thesleeve through a bore of the sleeve, and wherein the second constraintfeature comprises a hole that receives the shaft, so that the shaftrotates within the hole about a central longitudinal axis of the shaftand translates within the hole along the central longitudinal axis ofthe shaft; and a second adapter that is interchangeable with the firstadapter, the second adapter comprising a third constraint feature forconstrained articulation against a fourth constraint feature of thesecond arthroplasty prosthesis that is interchangeable with the secondconstraint feature, wherein the third constraint feature comprises acavity; and wherein the fourth constraint feature comprises a protrusionreceived in the cavity so that when the joint is extended, the secondarthroplasty prosthesis has limited translation along a direction thatis generally perpendicular to a mechanical axis of the first bone, andso that when the joint is flexed, the second arthroplasty prosthesis haslimited translation along a direction that is generally parallel to themechanical axis of the first bone.
 17. The arthroplasty system of claim16, wherein the first adapter is fixable to, and removable from, thefirst arthroplasty component when the first arthroplasty component isfixed to the first bone.
 18. The arthroplasty system of claim 17,wherein the first adapter is fixable to, and removable from, the firstarthroplasty component along a direction that is generally parallel to amechanical axis of the first bone when the first arthroplasty componentis fixed to the first bone.
 19. The arthroplasty system of claim 17,wherein the first adapter is fixable to, and removable from, the firstarthroplasty component along a direction that is generally perpendicularto a mechanical axis of the first bone from a generally anterior toposterior direction with respect to the first bone when the firstarthroplasty component is fixed to the first bone.
 20. The arthroplastysystem of claim 19, wherein: the direction that is generallyperpendicular to the mechanical axis of the first bone comprises anangle within + or −45 degrees from a direction perpendicular to themechanical axis of the first bone; and the generally anterior toposterior direction with respect to the first bone comprises an anglewithin + or −45 degrees from an anterior to posterior direction withrespect to the first bone.